Provider Demographics
NPI:1447439971
Name:DOUGHERTY, RETHA MARY (DC)
Entity type:Individual
Prefix:DR
First Name:RETHA
Middle Name:MARY
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S MAPLE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:PLAINVIEW
Mailing Address - State:NE
Mailing Address - Zip Code:68769-4154
Mailing Address - Country:US
Mailing Address - Phone:402-582-4901
Mailing Address - Fax:402-582-3901
Practice Address - Street 1:106 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NE
Practice Address - Zip Code:68769-4124
Practice Address - Country:US
Practice Address - Phone:402-582-4901
Practice Address - Fax:402-582-3901
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025575800Medicaid